482 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS
Psychiatric disorders are not diagnosed as easily in
children as they are in adults. Children usually lack
the abstract cognitive abilities and verbal skills to
describe what is happening. Because they constantly
are changing and developing, children have no sense
of a stable, normal self to allow them to discriminate
unusual or unwanted symptoms from normal feel-
ings and sensations. Additionally, behaviors that are
normal in a child of one age may indicate problems
in a child of another age. For example, an infant who
cries and wails when separated from her mother is
normal. If the same child at 5 years of age cries and
shows extreme anxiety when separated from her or
his mother, however, this behavior would warrant
investigation.
Children and adolescents experience some of the
same mental health problems as adults, such as mood
and anxiety disorders, and are diagnosed with these
disorders using the same criteria as for adults. Eat-
ing disorders, especially anorexia, usually begin in
adolescence and continue into adulthood. Discussions
of mood, anxiety, and eating disorders are presented
in separate chapters of this text.
This chapter focuses on those psychiatric dis-
orders usually first diagnosed in infancy, child-
hood, or adolescence (Box 20-1); many of these can
persist into adulthood. The childhood psychiatric
disorders most common in mental health settings
and specialized treatment units include pervasive
developmental disorders, attention deficit hyper-
activity disorder (ADHD), and disruptive behavior
disorders. For this reason, the chapter presents an
in-depth discussion of ADHD and conduct disorder
(the most prevalent disruptive behavior disorder)
with appropriate nursing diagnoses and interven-
tions as well as sample nursing care plans. It dis-
cusses less common disorders briefly; generally
most of these disorders are not treated in inpatient
psychiatric units unless they coexist with other
disorders.Box 20-1
➤ DISORDERSFIRSTDIAGNOSED ININFANCY, CHILDHOOD, ANDADOLESCENCE
MENTAL RETARDATION- Mild
- Moderate
- Severe
- Profound
LEARNING DISORDERS- Reading disorder
- Mathematics disorder
- Disorder of written expression
MOTOR SKILLS DISORDER- Developmental coordination disorder
COMMUNICATION DISORDERS- Expressive language disorder
- Mixed receptive and expressive language
disorder - Phonologic disorder
- Stuttering
PERVASIVE DEVELOPMENTAL DISORDERS- Autistic disorder
- Rett’s disorder
- Childhood disintegrative disorder
- Asperger’s disorder
ATTENTION DEFICIT AND DISRUPTIVE
BEHAVIOR DISORDERS- Attention deficit hyperactivity disorder
- Conduct disorder
- Oppositional defiant disorder
FEEDING AND EATING DISORDERS- Pica
- Rumination disorder
- Feeding disorder of infancy or early childhood
TIC DISORDERS- Tourette’s disorder
- Chronic motor or tic disorder
- Transient tic disorder
ELIMINATION DISORDERS- Encopresis
- Enuresis
OTHER DISORDERS OF INFANCY, CHILDHOOD,
OR ADOLESCENCE- Separation anxiety disorder
- Selective mutism
- Reactive attachment disorder
- Stereotypic movement disorder
Each category except feeding and eating disorders has an additional diagnosis “Not Otherwise Specified” (NOS) for similar
problems that do not meet the criteria for other diagnoses in the category (DSM-IV-TR, 2000). Adapted from DSM-IV-TR (2000).